局灶节段肾小球硬化症入住肾科ICU的原因和临床特征
发布时间:2018-05-24 02:26
本文选题:局灶节段肾小球硬化症 + 肾科ICU ; 参考:《南京大学》2014年硕士论文
【摘要】:目的:探讨局灶节段肾小球硬化症(FSGS)患者入住肾科重症监护病房(RICU)的原因及其临床特征。方法:观察2009年7月至2012年12月在南京军区南京总医院肾脏科RICU病房住院的FSGS患者,分析此类患者入住RICU原因、临床特点和既往治疗情况。结果:1)本研究共纳入48例FSGS患者,其中男性36例,女性12例,占所有RICU住院患者(共1626例)的2.93%,占肾病综合征患者(共153例)的31.37%,中位年龄23岁,中位肾脏病病程5.2月,42例(87.5%)患者尿蛋白定量3.5g/d。2)23例(47.9%)患者发生感染,以肺部感染(9例,39.1%)和皮肤软组织感染(6例,26.1%)为主,以肾脏病病程长并且对糖皮质激素治疗不敏感(激素抵抗)患者(10例,43.8%)为主。根据患者有无感染分为感染组(23例)和非感染组(25例)。与非感染组患者相比,感染组患者中位病程较长(8月VS 1.5月,P0.05),糖皮质激素和细胞毒药物使用率高(糖皮质激素:95.8%VS 63%,P0.05;细胞毒药物:43.5%VS 16%,P0.05)。3)31例(64.4%)患者发生急性肾损伤(AKI),1期、2期和3期各10、9和12例,其中19例(61.3%)患者起病时合并低血容量,14例(45.2%)患者为初次发病并且未使用糖皮质激素和细胞毒药物或刚接受上述药物治疗(初发初治)。根据患者有无AKI分为AKI组(31例)和非AKI组(17例)。与非AKI组患者相比,AKI组患者中激素抵抗者比例较低(16.1%VS 52.9%,P0.05),细胞毒药物使用率低(19.4%VS 47.1%,P0.05),而糖皮质激素使用率无差异。4)26例(54.2%)患者发生电解质紊乱,其中14例低钾血症、16例低钠血症。感染、AKI和电解质紊乱常重叠存在,12例感染合并AKI,14例感染合并电解质紊乱,16例AKI合并电解质紊乱,7例同时存在感染、AKI和电解质紊乱。结论:感染、AKI和电解质紊乱等是FSGS患者入住肾科ICU的主要原因,三者常重叠存在。感染在激素抵抗患者中发生率高,以肺部感染、皮肤软组织感染最多见,使用糖皮质激素和细胞毒药物是发生感染的危险因素。急性肾损伤在初发初治患者中发生率高,其中大部分患者存在肾脏血流灌注不足因素。
[Abstract]:Objective: to investigate the causes and clinical features of FSGSpatients with focal segmental glomerulosclerosis (FSGS) admitted to intensive care unit (ICU). Methods: from July 2009 to December 2012, the FSGS patients hospitalized in the RICU ward of Renal Department of Nanjing General Hospital of Nanjing military region were observed, and the causes, clinical characteristics and past treatment of RICU were analyzed. Results: a total of 48 patients with FSGS were included in the study, including 36 males and 12 females, accounting for 2.93% of all RICU inpatients (1626 cases) and 31.3737% of patients with nephrotic syndrome (153 cases), with a median age of 23 years. 42 patients with median kidney disease (n = 42) with urinary protein quantitative 3.5g/d.2)23 (n = 47.9) were infected by lung infection (n = 9) and skin and soft tissue infection (n = 6). Ten patients with long course of kidney disease and insensitive glucocorticoid therapy (hormone resistance) were mainly diagnosed. The patients were divided into infection group (n = 23) and non-infection group (n = 25). Compared with non-infected patients, In the infection group, the median course of disease was longer (August vs 1.5 months, P 0.05, glucocorticoid and cytotoxic drugs utilization rates were high (10 9 and 12 cases, respectively, 10 9 and 12 cases, respectively) with acute renal injury, stage 2, stage 2 and stage 3, respectively, were 109 and 12 cases, respectively, in 31 patients with acute renal injury. Among them, 19 cases (61.3) patients with hypovolemic syndrome (14 cases) were first onset and did not use glucocorticoid and cytotoxic drugs or just received the above drugs (initial treatment. According to the presence or absence of AKI, the patients were divided into AKI group (n = 31) and non AKI group (n = 17). Compared with the non-AKI group, the proportion of hormone resistance was lower (16.1vs 52.9V / P 0.05), and the utilization rate of cytotoxic drugs was 19.4VS 47.1P 0.05, but there was no difference in the utilization rate of glucocorticoid in 26 patients (54.2%). Among them, 14 cases had hypokalemia and 16 cases had hyponatremia. There were 12 cases of infection complicated with AKI and 14 cases of infection with electrolyte disorder. 16 cases of AKI complicated with electrolyte disorder were found in 7 cases, and the infection of AKI and electrolyte disorder were also found in 7 cases. Conclusion: infection with AKI and electrolyte disturbance are the main causes of ICU in patients with FSGS, and they often overlap. The incidence of infection was high in patients with hormone resistance, pulmonary infection and skin soft tissue infection were the most common. Glucocorticoid and cytotoxic drugs were the risk factors of infection. The incidence of acute renal injury was high in the patients with initial treatment, and most of the patients had insufficient renal perfusion.
【学位授予单位】:南京大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R692.6
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